Provider Demographics
NPI:1629374392
Name:DAVIS, MONEEKE (LPN)
Entity Type:Individual
Prefix:
First Name:MONEEKE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-4162
Mailing Address - Country:US
Mailing Address - Phone:216-926-6694
Mailing Address - Fax:
Practice Address - Street 1:2137 W 81ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-4162
Practice Address - Country:US
Practice Address - Phone:216-926-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140100164W00000X
CA95290032163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse